Contrast-Enhanced Ultrasound after Endovascular Aortic Repair: Supplement and Potential Substitute for CT in Early- and Long-Term Follow-Up.

BACKGROUND: Endoleaks are the most common complication after endovascular aneurysm repair (EVAR). Computed tomography angiography (CTA) is presently the golden standard for lifelong surveillance after EVAR. Several studies and meta-analyses have shown contrast-enhanced ultrasound (CEUS) to be a good alternative. The main goal of our study was to further validate the inclusion of CEUS in follow-up examination protocols for the systematic surveillance after EVAR. METHODS: A retrospective analysis of patients who had received CEUS as part of their routine surveillance after EVAR at our center was conducted. Detection rate and classification of endoleak types were compared between available postinterventional CTA/magnetic resonance angiography and follow-up CEUS examinations. Last preinterventional CTAs before EVAR served as baselines with focus on potential cofactors such as age, body mass index, maximum aortic aneurysm diameters, endoleak orientation, and distance-to-surface influencing detection rates and classification. RESULTS: In total, 101 patients were included in the analysis. Forty-four endoleaks (43.5% of cases) were detected by either initial CEUS or CTA, mostly type II (37.6% of the included patients). Initial CEUS showed an endoleak sensitivity of 91.2%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 84.6%. No covariate with an influence on the correct classification could be identified either for CEUS or CT. CONCLUSIONS: CEUS should be considered a valid complementary method to CTA in the lifelong surveillance after EVAR. As type II endoleaks seem to be a common early-term, sometimes spontaneously resolving complication that can potentially be missed by CTA, we suggest combined follow-up protocols including CEUS in the early on postinterventional assessment.

Superb microvascular ultrasound is a promising non-invasive diagnostic tool to assess a ventriculoperitoneal shunt system function: a feasibility study.

The objective of this pilot study was to assess the reliability of superb microvascular ultrasound (SMI) for the measurement of the cerebrospinal fluid (CSF) flow within VPS systems as an indirect sign for shunt dysfunction. Asymptomatic hydrocephalus patients, with a VPS system implanted between 2017 and 2021, were prospectively enrolled in the study. Using SMI, the CSF flow within the proximal and distal catheters were analysed. Before and after pumping the shunt reservoir, intraabdominal free fluid, optical nerve sheath diameter (ONSD), and papilla diameter (PD) were evaluated and correlated with the amount of valve activation. Nineteen patients were included. A flow was detectable in 100% (N = 19) patients in the proximal and in 89.5% (N = 17) in the distal catheter. The distal catheter tip was detectable in 27.7% (N = 5) patients. Free intraabdominal fluid was initially detected in 21.4% (N = 4) patients and in 57.9% (N = 11) at the end of the examination (P = 0.049). ONSD was significantly lower after pump activation (4.4 ± 0.9 mm versus 4.1 ± 0.8 mm, P = 0.049). Both peak velocity and flow volume per second were higher in proximal compared to distal catheters (32.2 ± 45.2 versus 5.6 ± 3.7 cm/sec, P = 0.015; 16.6 ± 9.5 ml/sec versus 5.1 ± 4.0 ml/sec, P = 0.001, respectively). No correlation was found between the number of pump activations and the changes in ONSD (P = 0.975) or PD (P = 0.820). SMI appears to be a very promising non-invasive diagnostic tool to assess CSF flow within the VPS systems and therefore affirm their function. Furthermore, appearance of free intraperitoneal fluid followed by repeated compression of a shunt reservoir indicates an intact functioning shunt system.

Operative versus conservative treatment of acute Achilles tendon ruptures: preliminary results of clinical outcome, kinematic MRI and contrast-enhanced ultrasound.

INTRODUCTION: There is no uniform consensus on the gold standard therapy for acute Achilles tendon rupture. The aim of this pilot study was to compare operative and conservative treatment regarding imaging findings and clinical outcome. MATERIALS AND METHODS: Surgically or conservatively treated patients with acute Achilles tendon rupture were retrospectively evaluated. Differences in tendon length and diameter with and without load were analysed using kinematic MRI, tendon perfusion, structural alterations, movement and scar tissue by means of grey-scale and contrast-enhanced ultrasound (CEUS). Intra- and interobserver agreement were recorded. RESULTS: No significant difference was detected regarding clinical outcome, B mode ultrasonography, contrast-enhanced sonography or MRI findings, although alterations in MRI-based measurements of tendon elasticity were found for both groups. Considerable elongation and thickening of the injured tendon were detected in both groups. CONCLUSION: Both, conservative and surgical treatment showed comparable outcomes in our preliminary results and may suggest non-inferiority of a conservative approach.

Chest CT of Lung Injury 1 Year after COVID-19 Pneumonia: The CovILD Study.

Background The long-term pulmonary sequelae of COVID-19 is not well known. Purpose To characterize patterns and rates of improvement of chest CT abnormalities 1 year after COVID-19 pneumonia. Materials and Methods This was a secondary analysis of a prospective, multicenter observational cohort study conducted from April 29 to August 12, 2020, to assess pulmonary abnormalities at chest CT approximately 2, 3, and 6 months and 1 year after onset of COVID-19 symptoms. Pulmonary findings were graded for each lung lobe using a qualitative CT severity score (CTSS) ranging from 0 (normal) to 25 (all lobes involved). The association of demographic and clinical factors with CT abnormalities after 1 year was assessed with logistic regression. The rate of change of the CTSS at follow-up CT was investigated by using the Friedmann test. Results Of 142 enrolled participants, 91 underwent a 1-year follow-up CT examination and were included in the analysis (mean age, 59 years ± 13 [SD]; 35 women [38%]). In 49 of 91 (54%) participants, CT abnormalities were observed: 31 of 91 (34%) participants showed subtle subpleural reticulation, ground-glass opacities, or both, and 18 of 91 (20%) participants had extensive ground-glass opacities, reticulations, bronchial dilation, microcystic changes, or a combination thereof. At multivariable analysis, age of more than 60 years (odds ratio [OR], 5.8; 95% CI: 1.7, 24; P = .009), critical COVID-19 severity (OR, 29; 95% CI: 4.8, 280; P < .001), and male sex (OR, 8.9; 95% CI: 2.6, 36; P < .001) were associated with persistent CT abnormalities at 1-year follow-up. Reduction of CTSS was observed in participants at subsequent follow-up CT (P < .001); during the study period, 49% (69 of 142) of participants had complete resolution of CT abnormalities. Thirty-one of 49 (63%) participants with CT abnormalities showed no further improvement after 6 months. Conclusion Long-term CT abnormalities were common 1 year after COVID-19 pneumonia. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Leung in this issue.

The effect of revascularization on recovery of mitochondrial respiration in peripheral artery disease: a case control study.

BACKGROUND: Peripheral arterial disease (PAD) is accompanied by myopathy characterized by mitochondrial dysfunction. The aim of this experimental study was to investigate the effect of revascularization procedures on mitochondrial function in ischemic and non-ischemic muscle. METHODS: Muscle biopsies from patients with symptomatic stage IIB/III PAD caused by isolated pathologies of the superficial femoral artery were obtained from muscle regions within the chronic ischemic muscle (gastrocnemius) and from non-ischemic muscle (vastus lateralis) before and 6 weeks after invasive revascularization. High-resolution respirometry was used to investigate mitochondrial function and results were normalized to citrate synthase activity (CSA). Results are given in absolute values and fold over basal (FOB). RESULTS: Respiratory states (OXPHOS (P) and electron transfer (E) capacity) normalized to CSA decreased while CSA was increased in chronic ischemic muscle after revascularization. There were no changes in in non-ischemic muscle. The FOB of chronic ischemic muscle was significantly higher for CSA (chronic ischemic 1.37 (IQR 1.10-1.64) vs. non-ischemic 0.93 (IQR 0.69-1.16) p = 0.020) and significantly lower for respiratory states normalized to CSA when compared to the non-ischemic muscle (P per CSA chronic ischemic 0.64 (IQR 0.46-0.82) vs non-ischemic 1.16 (IQR 0.77-1.54) p = 0.011; E per CSA chronic ischemic 0.61 (IQR 0.47-0.76) vs. non-ischemic 1.02 (IQR 0.64-1.40) p = 0.010). CONCLUSIONS: Regeneration of mitochondrial content and function following revascularization procedures only occur in muscle regions affected by malperfusion. This indicates that the restoration of blood and oxygen supply are important mediators aiding mitochondrial recovery.

Nutritive value for ruminants of different fresh and ensiled sorghum (Sorghum bicolor (L.) Moench) varieties harvested at varying maturity stages.

The occurrence of the Western corn rootworm and increasing frequency of summer droughts have reduced forage maize yields and quality in Central Europe in recent years. Therefore, sorghum (Sorghum bicolor (L.) Moench) has been increasingly used as alternative forage in ruminant feeding, although information on the nutritive value of whole crop sorghum silage (WCSS) under Central European climate conditions is scarce. This research project aimed to study differences between sorghum varieties and harvest dates regarding dry matter (DM) yield, chemical composition of fresh panicle, fresh stover, fresh whole plant and WCSS as well as whole tract digestibility and energy content of WCSS. For this purpose, six sorghum varieties, classified by their predominant use (biomass, silage, grain), were cultivated and harvested at three maturity stages (late milk stage, dough stage, full maturity). Furthermore, WCSS quality was compared with feed value of fresh and ensiled forage maize. Dry matter yield was higher (p < 0.05) in biomass sorghum (24.9 t/ha) compared to other sorghum varieties (12.4 to 16.7 t/ha). However, panicle proportion was lowest in biomass sorghum (10.5%), highest in grain sorghum (59.1%) and intermediate in silage sorghum. Fibre content declined and starch content increased with rising panicle proportion in fresh panicle, fresh whole plant and WCSS. Therefore, whole tract organic matter digestibility (66.8%) and metabolisable energy (ME) content (9.49 MJ/kg DM) were highest in grain sorghum silage. Especially low ME content was found in the biomass sorghum silage (7.43 MJ/kg DM). Dry matter yield of sorghum increased between late milk and dough stage of maturity, while it remained constant afterwards. Furthermore, ME content of WCSS rose tendentially (0.05 < p < 0.10) between late milk and dough stage of maturity and dropped again between dough stage and full maturity. Highest nutritive value of WCSS is achieved if grain sorghum varieties are used and both nutritive value and DM yield are optimised if harvest is carried out at dough stage of maturity. However, compared to forage maize, grain sorghum varieties have disadvantages both in DM yield and in nutritive value under common Central European climate conditions.

Evaluation of the net energy for lactation system and estimation of the energy requirements of dairy cows based on a comprehensive analysis of feeding trials.

Respiration experiments with high-yielding dairy cows in Northern Ireland have shown higher energy maintenance requirements than those used in the requirements standards of, e.g. France, UK, USA and Germany. Therefore, the current net energy for lactation (NEL) system of Germany was tested by comparing measured NEL intake with calculated NEL requirements based on a comprehensive dataset from feeding trials conducted at nine research institutions in Germany, Austria and Switzerland. The relationship between NEL requirements and NEL intake is described by the equation: N E L r e q u i r e m e n t s M J / d = 26 . 6 ± 0 . 4 + 0 . 82 ± 0 . 004 ⋅ N E L i n t a k e M J / d w i t h C o e f f i c i e n t   o f   D e t e r m i n a t i o n   R 2 = 0 . 677 , R o o t   M e a n   S q u a r e   E r r o r   R M S E   = 15 . 9   M J   N E L . The equation indicates a systematic over-estimation of NEL requirements in the lower performance range and an under-estimation at higher energy intake levels. A multiple regression analysis was conducted by calculating metabolisable energy (ME) requirements [MJ/d] using metabolic body size (MBS) [kg0.75], milk energy performance (LE) [MJ/d] and body weight change (BWC) [kg/d]: ​ ​ ​ ​ ​ ​ ​ ME intake ( MEI ) [ MJ ] =0 . 651 ( ± 0 . 004 ) ⋅ MBS+1 . 37 ( ± 0 . 006 ) ⋅ LE + 16 . 6 ( ± 0 . 31 ) ⋅ BWC with R 2 = 0. 717 , RMSE=24 . 0 MJ . These results indicate that the energy maintenance requirements are markedly higher than presumed in the feed evaluation systems commonly in use but confirm the results from Northern Ireland (0.600-0.660 MJ ME/kg0.75 MBS). ME efficiency for lactation is also higher (kL = 1/1.37 = 0.73) than that used in the systems and is also similar to the results of Northern Ireland with 0.64-0.69. The energy contribution of BWC derived by this equation is 12.1 MJ/kg (16.6 · 0.73) and distinctly lower than that of 21-25 MJ/kg presumed by the feeding standards, e.g. in Germany. Further, maintenance requirements were linked to milk yield (energy corrected milk (ECM) [kg/d]), as is practiced in the standard Australian energy system: ​ ​ ​ ​ ​ ​ ​ ( MEI ) [ MJ ] =0 . 640  + 0 . 0070 ⋅  ECM) ] ⋅ MBS+1 . 12) ⋅ LE + 16 . 7 ⋅  BWC with R 2 = 0. 719 , RMSE=24 . 0 MJ . These results demonstrate that maintenance energy requirements are partly dependent on milk yield. A differentiated analysis by stage of lactation showed that the regressions coefficients for MBS, LE and BWC change with lactation month; however, these findings apply especially to the first lactation months (i.e. in phases of intensive mobilisation).

Compliance assessment and flip-angle measurement of the median nerve: sonographic tools for carpal tunnel syndrome assessment?

OBJECTIVES: To assess the diagnostic performance of median nerve (MN) flip-angle measurements, deformation during wrist flexion [transit deformation coefficient (TDC)], during compression [compression deformation coefficient (CDC)] and fascicular freedom to potentially identify fibrotic MN changes in patients with carpal tunnel syndrome (CTS). METHODS: This prospective study was performed with institutional review board approval; all participants provided oral and written informed consent. Wrists in 21 healthy participants and 29 patients with CTS were examined by ultrasound. MN movement during wrist flexion, MN deformation during transition over the flexor tendons (TDC) and during controlled compression (CDC) as well as fascicular freedom were assessed. Diagnostic properties of these parameters were calculated and compared to clinical findings and cross-section area measurements (ΔCSA). RESULTS: Low flip angles were associated with high ΔCSA at a receiver-operator characteristics area under the curve (AUC) of 0.62 (0.51-0.74). TDC [AUC, 0.83 (0.73-0.92), 76.3% (59.8-88.6%) sensitivity, 88.5% (76.6-95.7%) specificity], restricted fascicular movement [AUC, 0.86 (0.78-0.94), 89.5% (75.2-97.1%) sensitivity, 80.8% (67.5-90.4%) specificity] and compression-based CDC [AUC, 0.97 (0.94-1.00), 82.1% (66.5-92.5%) sensitivity, 94.2% (84.1-98.8%) specificity] demonstrated substantial diagnostic power (95% confidence intervals in parentheses). CONCLUSIONS: Fascicular mobility, TDC and CDC show substantial diagnostic power and may offer insights into the underlying pathophysiology of CTS. KEY POINTS: • Dynamic ultrasonography during wrist flexion and compression enables median nerve deformability assessment. • Overall, reduced median nerve deformability is highly indicative of CTS. • Median nerve compressibility shows higher diagnostic power than conventional cross-section area measurements.

Retrospective analysis of the development of PIRADS 3 lesions over time: when is a follow-up MRI reasonable?

PURPOSE: Often PIRADS 3 findings are usually followed up with further MRIs of the prostate. Current guidelines do not state an optimal interval between the initial MRI and the follow-up MRI. The aim of this study was to find out if PIRADS 3 lesions evolve over time and to determine how long the optimal interval between initial MRI and follow-ups should be. METHODS: In this retrospective study, 141 consecutive patients were included who underwent at least one follow-up MRI after an initial PIRADS 3 finding. Changes in PIRADS score and the interval between the first and the follow-up MRI were recorded. An optimal duration was calculated. RESULTS: Of all patients, 76.6% had a change from PIRADS 3 to either 2 or 4 in the first follow-up MRI. Reclassifications to PIRADS 4 happened earlier than reclassifications to PIRADS 2 (after 366.5 ± 217.9 days and after 534.2 ± 253.0 days, respectively). An optimal point of time for a follow-up to distinguish between changes to PIRADS 2 versus PIRADS 4 turned out to be 379 days (12.4 months, AUC 0.734, p = 0.0001). Of all patients with a PIRADS 3 lesion 14.8% harboured a prostate carcinoma. CONCLUSION: Performing follow-up mpMRI rather than immediate biopsy may be beneficial for patients with PIRADS 3, as most lesions can be reclassified after a manageable period of time. Upgrades to PIRADS 4 seem to happen earlier and within fewer follow-ups than downgrades to PIRADS 2. The optimal interval for follow-up MRIs seems to be 12.4 months.

CAIPIRINHA-Dixon-TWIST (CDT)-VIBE MR imaging of the liver at 3.0T with gadoxetate disodium: a solution for transient arterial-phase respiratory motion-related artifacts?

PURPOSE: To determine whether CAIPIRINHA-Dixon-TWIST (CDT) volume-interpolated breath-hold examination (VIBE) improves image quality by reducing gadoxetate-disodium-associated transient arterial-phase motion artefacts in magnetic resonance imaging (MRI) of the liver. MATERIALS AND METHODS: MRI studies of the liver from 270 patients who had received gadoxetate disodium were retrospectively evaluated in regard to arterial timing accuracy and arterial phase motion artefact severity (VIBE: 90/270, CAIPIRINHA-VIBE: 90/270 and CDT-VIBE: 90/270 cases). Three independent and blinded readers assessed arterial phase timing and motion artefact severity (5-point scale). Interrater agreement was calculated by weighted kappa. Continuous variables were compared via a two-sided ANOVA, categorical variables via a χ2 test. An ordinal regression analysis was performed to identify other predictors of motion artefacts. RESULTS: CDT-VIBE improved correct late arterial timing rates and reduced motion-related image deterioration rates. Successful late arterial liver visualisation was achieved in 56.7% (VIBE) compared with 66.7% (CAIPIRINHA-VIBE) and 84.4% (CDT-VIBE) (P < 0.0001). Good/excellent image quality was achieved in 56.7% vs. 66.7% and 73.3%, respectively (P = 0.03). Male sex negatively influenced image quality (P = 0.03). CONCLUSION: CDT-VIBE increases the diagnostic utility of gadoxetate disodium-based liver MRI by reducing respiratory motion artefacts and optimising late arterial visualisation compared with VIBE and CAIPIRINHA-VIBE. KEY POINTS: • CAIPIRINHA-Dixon-TWIST-VIBE-MRI (CDT) mitigates effects of acute transient dyspnoea caused by gadoxetate disodium. • CDT improves late arterial imaging compared with VIBE and CAIPIRINHA-VIBE. • The rate of ideal late arterial images is higher with CDT-VIBE vs. VIBE or CAIPI-VIBE. • The impact of respiratory motion artefacts on arterial phase images can be reduced.

Nutrient composition, ruminal degradability and whole tract digestibility of whole crop maize silage from nine current varieties.

Since maize silage is an important forage in cattle nutrition, it is important to know its nutritive value. Much effort is put into breeding maize, and several new varieties are introduced on the market every year. This requires periodical analyses of the nutritive value of current maize varieties for the formulation of cattle rations. The aim of this study was to examine the nutritive value of whole crop maize silage (WCMS) from nine maize varieties in 3 consecutive years. For the analysis of nutrient composition and ruminal degradability of organic matter (OM), crude protein (CP), neutral detergent fibre (aNDFom) and non-fibre carbohydrates (NFC), varieties were harvested at three harvest dates (50%, 55% and 60% dry matter content in ear). Due to capacity limitations, the digestibility of WCMS was tested only for the middle harvest date. The CP and acid detergent fibre (ADFom) content was affected (p < 0.05) while aNDFom and NFC content was not influenced by variety. With advancing maturity, CP, aNDFom and ADFom content declined while NFC content increased. Variety influenced effective ruminal degradability (ED) of nutrients, except for CP. The ED of all examined nutrients decreased as maturity advanced from first to third harvest date. Digestibility of OM, ADFom and NFC was significantly and digestibility of aNDFom was tendentially (p = 0.064) influenced by variety. Additionally, an effect of year and a harvest date × year interaction was found for almost all examined parameters. In conclusion, variety, harvest date and year influence the nutritive value of WCMS. A comparison with earlier studies shows that current varieties have a higher fibre digestibility and a slower-ripening stover compared to older varieties.

Effects of feeding high-quality hay with graded amounts of concentrate on feed intake, performance and blood metabolites of cows in early lactation.

Dairy cows are commonly fed energy-dense diets with high proportions of concentrate feedstuffs to meet the increased energy needs of early lactation. However, feeding large amounts of concentrates may cause rumen acidosis and impact cow health. The hypothesis tested was that the energy supply and metabolic health of early-lactation Simmental cows can be maintained when high-quality hay rich in water-soluble carbohydrates (WSC) and crude protein (CP) is fed, despite the proportion of concentrates in the diet being reduced or even excluded. Twenty-four Simmental cows were allocated to one of four feeding groups beginning 10 d before the expected calving date, until 28 d thereafter. The feeding groups were 60CH (60% conventional fibre-rich hay plus 40% concentrate feed), 60HQH (60% high-quality hay plus 40% concentrate feed), 75HQH (75% high-quality hay plus 25% concentrate feed) and 100HQH (100% high-quality hay). The fibre-rich hay and high-quality hay differed in WSC content (110 g vs. 198 g of dry matter (DM)), neutral detergent fibre (646 g vs. 423 g of DM) and CP (65 g vs. 223 g of DM). Individual feed intake and milk production were monitored daily, and blood samples were collected weekly. Dry matter intake (DMI) and milk yield increased post partum, but 4 weeks post partum, the DMI of cows fed 100HQH only reached a daily mean DMI of 18.6 kg, whereas the DMI of the other groups averaged 21.9 kg (p < 0.046). The negative energy balance was less pronounced in cows fed 75HQH since they showed similar milk yields to the cows fed 60CH and 100HQH, but their energy intake was higher. Concentrations of milk components were similar across rations 60CH, 60HQH and 75HQH, as were most of blood parameters. Cows fed 100HQH responded to the energy deficit post partum with a higher ratio of non-esterified fatty acids to cholesterol and a higher concentration of ß-hydroxybutyrate (significant in comparison to cows fed 75HQH, p < 0.05). In conclusion, feeding high-quality hay with a WSC content of 20% in DM has the potential to decrease the proportion of concentrates in dairy cow feeding in early lactation, but cannot fully replace their supplementation due to a limited rumen capacity for forage intake.

Value of Multiparametric US in the Assessment of Intratesticular Lesions.

Purpose To evaluate the diagnostic accuracy of multiparametric ultrasonography (US) consisting of gray-scale US, color Doppler US, strain elastography, and contrast agent-enhanced US in the assessment of intratesticular lesions. Materials and Methods Institutional review board approval was obtained for this retrospective study. From January 2012 to December 2015, 55 focal testicular lesions that were indeterminate on gray-scale US scans were further characterized with color Doppler US, strain elastography, and contrast-enhanced US. Strain elastography was performed to assess tissue elasticity, and hard lesions were defined as malignant. Color Doppler US and contrast-enhanced US were performed to determine the absence or presence of vascularization. Avascular lesions were defined as benign. Histopathologic results or follow-up examinations served as reference standards. Correct classification rate, sensitivity, specificity, and likelihood ratio were calculated. Results Of 55 testicular lesions, 43 (78.2%) were benign and 12 (21.8%) were malignant. Single-modality sensitivities and specificities were 66.7% and 88.4% for color Doppler US, 100% and 76.7% for contrast-enhanced US, and 100% and 72.1% for strain elastography, respectively. Among 12 malignant lesions, color Doppler US failed to demonstrate vascularization in four (33.3%) lesions, which were positive for cancer at contrast-enhanced US. By combining strain elastography and contrast-enhanced US, a sensitivity of 100% and specificity of 93.0% were achieved in differentiating benign and malignant focal testicular lesions. Positive likelihood ratio was 5.7 for color Doppler US, 4.3 for contrast-enhanced US, 3.6 for strain elastography, 14.3 for strain elastography combined with color Doppler US, and 14.3 for strain elastography combined with contrast-enhanced US. Conclusion Multiparametric US allows for a reliable differentiation of benign and malignant intratesticular lesions and can potentially be useful in deciding whether orchiectomy can be replaced with follow-up or less invasive organ-sparing strategies. © RSNA, 2017.

Sonoelastography of the Common Flexor Tendon of the Elbow with Histologic Agreement: A Cadaveric Study.

Purpose To determine the correlation of the results of conventional B-mode ultrasonography (US) and compression sonoelastography with histologic results in common flexor tendons of the elbow in human cadavers. Materials and Methods Twenty-five common flexor tendons were evaluated in 16 fresh, unembalmed cadavers of 11 women with a median age of 85 years (range, 71-101 years) and five men with a median age of 78 years (range, 70-88 years). Informed consent was provided according to the last will of the donors. B-mode US results were classified as grade 1, normal tendon with homogeneous fibrillar pattern; grade 2, tendon thickening or hypoechoic areas and/or calcifications in less than 30% of the tendon; or grade 3, hypoechoic areas and/or calcifications greater than 30% of the tendon. Sonoelastographic results were grade 1, blue (hardest) to green (hard); grade 2, yellow (soft); and grade 3, red (softest). The intraclass correlation coefficient was calculated to determine agreement with histologic findings for each B-mode US, sonoelastographic, and combined B-mode US and sonoelastographic examination. Histologic results were grade 1, normal, with parallel fibrillar pattern; grade 2, mild tendinopathy, with cellular infiltration, angiogenesis, or fatty vacuoles; or grade 3, severe tendinopathy, with loss of parallel collagen structure and necrosis. Results Histologic alterations were detected in 44% (11 of 25) of biopsy specimens. Intraclass correlation with histologic results was 0.57 for B-mode US, 0.68 for sonoelastography, and 0.84 for the combination of the two approaches. Conclusion The addition of sonoelastography to B-mode US provided statistically significant improvement in correlation with histologic results compared with the use of B-mode US alone (P < .02). © RSNA, 2016 Online supplemental material is available for this article.

The 68Ga/177Lu theragnostic concept in PSMA targeting of castration-resistant prostate cancer: correlation of SUVmax values and absorbed dose estimates.

INTRODUCTION: A targeted theragnostic approach based on increased expression of prostate-specific membrane antigen (PSMA) on PC cells is an attractive treatment option for patients with metastatic castration-resistant prostate cancer (mCRPC). METHODS: Ten consecutive mCRPC patients were selected for 177Lu-PSMA617 therapy on the basis of PSMA-targeted 68Ga-PSMA-HBED-CC PET/CT diagnosis showing extensive and progressive tumour load. Following dosimetry along with the first therapy cycle restaging (68Ga-PSMA-HBED-CC and 18F-NaF PET/CT) was performed after 2 and 3 therapy cycles (each 6.1 ± 0.3 GBq, range 5.4-6.5 GBq) given intravenously over 30 minutes, 9 ± 1 weeks apart. PET/CT scans were compared to 177Lu-PSMA617 24-hour whole-body scans and contrast-enhanced dual-phase CT. Detailed comparison of SUVmax values and absorbed tumour doses was performed. RESULTS: 177Lu-PSMA617 dosimetry indicated high tumour doses for skeletal (3.4 ± 1.9 Gy/GBq; range 1.1-7.2 Gy/GBq), lymph node (2.6 ± 0.4 Gy/GBq; range 2.3-2.9 Gy/GBq) as well as liver (2.4 ± 0.8 Gy/GBq; range 1.7-3.3 Gy/GBq) metastases whereas the dose for tissues/organs was acceptable in all patients for an intention-to-treat activity of 18 ± 0.3 GBq. Three patients showed partial remission, three mixed response, one stable and three progressive disease. Decreased 177Lu-PSMA617 and 68Ga-PSMA-HBED-CC uptake (mean SUVmax values 20.2 before and 15.0 after 2 cycles and 11.5 after 3 cycles, p < 0.05) was found in 41/54 skeletal lesions, 12/13 lymph node metastases, 3/5 visceral metastases and 4/4 primary PC lesions. CONCLUSION: Due to substantial individual variance, dosimetry is mandatory for a patient-specific approach following 177Lu-PSMA617 therapy. Higher activities and/or shorter treatment intervals should be applied in a larger prospective study.

Soft-Tissue Tumor Contrast Enhancement Patterns: Diagnostic Value and Comparison Between Ultrasound and MRI.

OBJECTIVE: The purpose of this study was to assess and compare contrast-enhanced ultrasound and MRI patterns in the diagnosis of soft-tissue masses. MATERIALS AND METHODS: Two hundred fifty-five consecutively registered patients with histologically confirmed soft-tissue masses were included in this retrospective study. The diagnostic properties of four predefined contrast enhancement (CE) patterns were assessed, and logistic regression analysis was performed to determine the correlation between diagnosis and CE pattern, lesion size, and patient age and sex. The influence of lesion size on the occurrence of inhomogeneous CE patterns in malignancies was also determined. RESULTS: Homogeneous CE patterns were highly specific for benignity, and inhomogeneous CE was moderately specific for malignancy in both ultrasound and MRI. A combination of homogeneous and inhomogeneous CE patterns led to 88.3% and 88.7% sensitivity, 66.7% and 59.7% specificity, 73.4% and 68.2% correct classification, 54.6% and 47.8% positive predictive value, 92.6% and 92.7% negative predictive value, 2.65 and 2.20 positive likelihood ratio, and 0.18 and 0.19 negative likelihood ratio for contrast-enhanced ultrasound and contrast-enhanced MRI. Cases with homogeneous CE in either ultrasound or MRI also were predominantly benign. The occurrence of inhomogeneous CE in malignant lesions increased with size. CONCLUSION: CE patterns in ultrasound and MRI offer additional information about the differentiation of an unknown soft-tissue mass. The results of this study showed that homogeneous or absent CE was specific for benign differentiation and that heterogeneous CE was linked to malignancy. The routine analysis of CE patterns should increase diagnostic reliability in unclear soft-tissue masses.

Effect of variety and harvest date on nutritive value and ruminal degradability of ensiled maize ears.

The nutritive value of whole crop forage maize is influenced by the proportion of ears and stover in the whole crop and by the nutrient composition and digestibility characteristics of the plant parts. An experiment investigating the impact of variety, harvest date and year on the nutritive value of ensiled maize ears was carried out in three consecutive years (2007, 2008 and 2010). Nine different maize varieties were harvested at three different maturity stages (50, 55 and 60% dry matter (DM) content in the ears). After harvest, ears and stover were ensiled separately and afterwards nutrient composition and ruminal nutrient degradability (organic matter (OM), crude protein (CP) and non-fibre carbohydrates (NFC)) were analysed. Variety had a significant influence on content of CP and effective ruminal degradability (ED) of OM at low passage rates, whereas ED of CP and NFC was not affected by variety. In contrast, harvest date and year significantly influenced nutrient composition and ruminal degradability of ensiled maize ears. The content of NFC increased and the content of fibre components as well as ED of OM, CP and NFC declined with processing maturity of the maize plants. At a passage rate of 5% h-1, ED of OM declined from 75.9% to 68.4%, ED of CP from 82.5% to 73.8% and ED of NFC from 88.0% to 82.3% between the early and late harvest date. The results of this study indicate that the nutrient composition and ruminal degradability of ensiled maize ears are affected mainly by maturity stage at harvest and by year, whereas variety has only little influence.

Long-term influence of feeding barley treated with lactic acid and heat on performance and energy balance in dairy cows.

The study evaluated the long-term influence of feeding ground barley treated with lactic acid (LA) alone or with LA and heat on performance, energy and protein balance in dairy cows. Thirty cows were fed three diets differing in the treatment of barley grain, either unprocessed ground barley (Control), ground barley steeped in 1% LA at room temperature (LA-treated barley) or ground barley steeped in 1% LA with an additional heating at 55°C (LAH-treated barley). Cows were studied from week 3 to 17 post-partum. Dry matter intake (DMI), milk yield and composition and body weight (BW) were measured daily. Estimated energy and protein balances were calculated and blood samples were collected three times during the experiment and analysed for common metabolites of energy and lipid metabolism. Digestibility of different treated barley and other dietary ingredients was investigated in vivo using four wethers. The treatment of barley with LA and LAH increased the digestibility of organic matter (OM) by approximately 5% and the content of metabolisable energy by 0.5-0.6 MJ/kg DM. Data showed no effect of feeding diets containing LA- or LAH-treated barley at 39% of DM on overall DMI, BW, BW change, milk production and composition and on the blood variables studied. Diet influenced the estimated balances of net energy of lactation (p < 0.01) and the content of utilisable protein at the duodenum (p = 0.07) with cows fed the diet with LA-treated barley showing improved balances. In conclusion, feeding diets containing LA- or LAH-treated barley had no influence on performance, milk composition and blood metabolites, but LA treatment without heat seems to improve the energy balance of cows.

A case of crossed-doubled patellar tendon: an atavistic variant, simple mutation or pathologic finding?

Anatomical variants can be found throughout the whole body. Especially in the knee region, some variability has been reported concerning the osseous, tendinous, and muscular system. Beside a few cases of patellar tendon aplasia, no anatomical variations of this tendon are known. We present a rare case of a doubled patellar tendon as an anatomical variant, which to our knowledge, has not been described previously.

Does size reliably predict malignancy in soft tissue tumours?

PURPOSE: In this retrospective study we examined whether size is a viable marker of tumour malignancy in soft tissue masses (STM) and if the ratio of width and length (RALD) of an STM reflects tumour biology more accurately. METHODS: Measurements of maximal lesion size and perpendicular diameter were performed in available MRI and ultrasonography studies of 212 patients (mean age 54.4 ± 17.2 years, male:female 1:1.12) with a histologically verified diagnosis. RESULTS: Overall, 28.2 % of lesions were malignant, 11.1 % intermediate, and 58.8 % benign. Size alone was a weak predictor of malignancy in STMs (sensitivity 68.8 %, specificity 50.3 %, positive predictive value [PPV] 44.0 %, negative predictive value [NPV] 80.4 %). RALD showed better discriminatory power with greater separation between benign and malignant entities and higher values for sensitivity (83.6 %), specificity (53.6 %), and NPV (89.0 %). A weighted combination of size, age and RALD improved diagnostic power, demonstrating higher values for sensitivity (77.0 %), specificity (80.1 %), PPV (61.0 %), and NPV (89.6 %). CONCLUSIONS: Size should not be used alone to estimate an STM's malignancy. RALD better reflects a lesion's growth pattern and a combination of age, size, and RALD helps to discriminate more accurately between benign, intermediate, and malignant entities. These findings should help to estimate easily whether a newly found STM is benign or malignant prior to further workup. KEY POINTS: •Size does not reliably differentiate between benign, intermediate, and malignant tumours •The R ALD (ratio of lateral to axial diameter) improves diagnostic confidence •When combined with age and size, STM differentiation was further enhanced •These measurements can aid in earlier detection of sarcomas.